Federal Skilled Worker Assessment Form
For applicants qualifying on the basis of their educational background
 and professional expertise

1)  Personal Information
Family Name:               First Name: 
Date of birth:    (dd/mm/yyyy)
Country of Citizenship: 
City and Country where you are currently residing: 

Gender:   Male      Female

2) Contacting Information
Email: 
Telephone Number : 
Fax Number (OPTIONAL): 
Postal Address (OPTIONAL): 

3) Key Factors
Your age: 
Education:       Major: 
Completed? Yes     No     In Progress  
Years of Completion (elementary – last degree/diploma): 

Current Occupation:       Years of exp 
Previous Occupation:       Years of exp   

Do you have an Offer of Employment in Canada approved by HRDC?     Yes    No  

4) Education
Primary School  Secondary School    High School
  1 year equivalent full time studies/training leading to a diploma
  2 years equivalent full time studies/training leading to a diploma
  3 years equivalent full time studies/training leading to a diploma

5) Work Experience
List your work experience along with details of position, responsibilities etc.
 

6) Official Languages
Please indicate your abilities in both English and French languages, as follows: 

7) Employer information (if applicable)
Information regarding Canadian Business, Employer or intended business activity

Have you been made an offer by a Canadian Business or Employer?  Yes   No

If No offer exists from a Canadian business or employer, 
please explain the nature of your intended business visit:

If Yes
Name of Employer/Business: 
Business Address: 
Position Offered: 

Are you being transferred from a foreign enterprise to a Canadian branch, affiliate, parent or subsidiary?
Yes No

8) Additional Information

9) Available Funds
Liquid Assets
Fixed Assets

10) How did you find us?

Choose one of the options Search Engine www.zeyrozabar.com Other Website Newspaper Ad Radio Ad Television Ad Referred by someone Other